Warning

CMS: RACs Delay Review of 2-Midnight Rule

The Centers for Medicare & Medicaid Services announced that the recovery auditors will not review claims spanning two midnights after admission for appropriateness of patient status between Oct. 1 and Dec. 31, 2013 — what CMS is describing as an implementation period.

The announcement was posted yesterday on the CMS website. CMS went on to say that MACs and RACs will not review any claims related to Critical Access Hospitals. Furthermore, CMS stated that it would not permit RACs to review inpatient admissions of one midnight or less that occur on or after Oct. 1.

CMS advised hospitals that while medical review will not be focused on claims spanning two midnights or more after formal inpatient admission, “physicians should make inpatient admission decisions in accordance with the two midnight provisions in the final rule.”

CMS also sent a warning to hospitals stating, “if at any time there is evidence of systematic gaming, abuse or delays in the provision of care in an attempt to surpass the two-midnight presumption could warrant medical review.”